ASSESSMENT OF LIPID DYSFUNCTION IN PATIENTS ON MAINTENANCE HAEMODIALYSIS
AbstractBackground: Dyslipidaemia is a major risk factor of cardiovascular disease in patients onmaintenance haemodialysis. Both increased and decreased levels of cholesterol are associatedwith increased cardiovascular mortality in haemodialysis patients. Objective: To assess the lipiddysfunction among patients on maintenance haemodialysis in a nephrology unit at Rawalpindi ascompared with healthy individuals. Methodology: A descriptive comparative study was carriedout in a nephrology unit at Rawalpindi, Pakistan. A total of 140 subjects were included consistingof 70 patients on maintenance haemodialysis (MHD) and 70 healthy controls. Body mass index(BMI) was measured according to WHO guidelines. Serum total cholesterol (TC), triglycerides(TG) and high-density lipoprotein cholesterol (HDL-C) were assayed on chemistry analyser.Low-density lipoprotein cholesterol (LDL-C) was calculated by Friedwald equation. Result:MHD patients had significantly lower BMI, mean (SD) 20.07(3.66) as compared with the controls22.88(3.97) kg/m2 (p<0.001). The lipid profile among MHD patients and controls are given asmean (SD): (a) Total Cholesterol 3.84(1.06) vs 4.65(0.97) (p<0.001), (b) LDL-C 2.21(0.77) vs2.93(0.71) (p<0.001), (c) HDL-C 0.95(0.166) vs 0.97(0.138) (p=NS), (d) Non HDL 2.88(0.95) vs3.67(0.88) (p<0.0001), (e) Triglycerides 1.68(1.09) vs 1.69(0.86) (p=NS). The most commonabnormality observed in haemodialysis patients was low HDL-C (81%) followed by increasedNon-HDL-C (23%) and increased serum triglycerides (19%). Conclusion: It is concluded thatour patients on maintenance haemodialysis have significantly low BMI, total Cholesterol, LDL-Cand Non-HDL-C depicting malnutrition leading to inflammation, accelerated atherosclerosisprocess and cardiovascular complications.Key words: total Cholesterol, lipoproteins, BMI, haemodialysis, cardiovascular disease
Pennell P, Leclercq B, Delahunty MI, Walters BA.. The utility
of non-HDL in managing dyslipidemia of stage 5 chronic
kidney diseases. Clin Nephrol 2006 Nov; 66(5):336-47.
Abrass CK. Lipid metabolism and renal disease. Contrib
National Kidney Foundation. K/DOQI clinical practice
guidelines for chronic kidney disease: Evaluation,
classification, and stratification. Am J Kidney Dis.
Gowdak LH, Arantes RL, de Paula FJ, Krieger EM, De Lima
JJ. Under use of American College of Cardiology/American
Heart Association Guidelines in hemodialysis patients. Ren
Soubassi LP, Papadakis ED, Theodoropoulos IK, Poulos GD,
Chaniotis D, Tsapakidis IP et al. Incidence and risk factors of
coronary artery disease in patients on chronic hemodialysis.,
Int Artif Organs 2007 Mar;30(3):253-7.
Al Wakeel JS, Mitwalli AH, Al Mohaya S, Abu-Aisha H,
Tarif N, Malik GH, et al. Morbidity and mortality in ESRD
patients on dialysis. Saudi J Kidney Dis Transpl. 2002
Muntner P, He J, Astor BC, Folsom AR, Coresh J.
Traditional and nontraditional risk factors predict coronary
heart disease in chronic kidney disease: results from the
atherosclerosis risk in communities study. J Am Soc Nephrol.
National Kidney Foundation. K/DOQI clinical practice
guidelines for managing dyslipidemias in chronic kidney
disease. Am J Kidney Dis. 2003;41(suppl 3):S1-S92.
Iseki K, Yamazato M, Tozawa M, Takishita S.
Hypocholesterolemia is a significant predictor of death in a
cohort of chronic hemodialysis patients. Kidney Int
Liu Y, Coresh J, Eustace JA, Longenecker JC, Jaar B, Fink
NE, et al. Association between cholesterol level and
mortality in dialysis patients: role of inflammation and
malnutrition. JAMA 2004;291:451-9.
Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD.
Reverse epidemiology of cardiovascular risk factors in
maintenance dialysis patients. Kidney 2003 Mar;63(3):793-808
Allain CC, Poon LS, C.S.G, Richmond, W and Fu.
Enzymatic determination of serum cholesterol. P.D.
Fossati R, Prencipe L. Serum triglycerides determined
colorimetrically with an enzyme that produces hydrogen
peroxide. Clin Chem 1982;28:2077.
Friedwald WT, Levy RI, Fredrickson DS. Estimation of the
concentration of low-density lipoprotein cholesterol in
plasma without use of preparative ultracentrifuge. Clin Chem
Bednarek-Skublewska A, Baranowicz-Gaszczyk I, Jóźwiak
L, Dzik M, Majdan M, Ksiazek A. Comparison of some
nutritional parameters in hemodialysis patients over and
below 65 years of age. Pol Arch Med Wewn. 2005 May;
Basaleem HO, Alwan SM, Ahmed AA, Al-Sakkaf KA.
Assessment of the nutritional status of end-stage renal disease
patients on maintenance hemodialysis. Saudi J Kidney Dis
Transpl. 2004 October-ecember;15(4):455-6.
Torun D, Micozkadioglu H, Torun N, Ozelsancak R, Sezer S,
Adam FU et al. Increased body mass index is not a reliable
marker of good nutrition in hemodialysis patients. Ren Fail.
Physical status: the use and interpretation of anthropometry.
Report of a WHO Expert Committee. Geneva, World health
Organization, 1995 (WHO Technical Report Series, No.854).
Johansen KL, Young B, Kaysen GA, Chertow GM.
Association of body size with outcomes among patients
beginning dialysis. Am J Clin Nutr 2004;80:324-32.
Leavey SF, McCullough K, Hecking E, Goodkin D, Port FK,
Young EW. Body mass index and mortality in 'healthier' as
compared with 'sicker' haemodialysis patients: Results from
the Dialysis Outcomes and Practice Patterns Study (DOPPS).
Nephrol Dial Transplant 2001;16:2386-94.
Kalantar-Zadeh K, Kilpatrick RD, Kopple JD, Stringer WW.
A matched comparison of serum lipids between hemodialysis
patients and nondialysis morbid controls. Hemodial Int. 2005
Longenecker JC; Coresh J; Powe NR; Levey AS; Fink NE;
Martin A et al. Traditional cardiovascular disease risk factors
in dialysis patients compared with the general population: the
CHOICE Study. J Am Soc Nephrol 2002 Jul;13(7):1918-27.
Desmeules S, Arcand-Bossé JF, Bergeron J, Douville P,
Agharazii M. Nonfasting non-high-density lipoprotein
J Ayub Med Coll Abbottabad 2007;19(4)
cholesterol is adequate for lipid management in hemodialysis
patients. Am J Kidney Dis. 2005 Jun;45(6):1067-72.
Caparević Z, Kostić N. The influence of age and the
beginning of menopause on the lipid status, LDL oxidation,
and CRP in healthy women. Srp Arh Celok Lek. 2007 MayJun;135(5-6):280-5.
Trémollières FA, Pouilles JM, Cauneille C, Ribot C. Coronary
heart disease risk factors and menopause: a study in 1684
French women. Atherosclerosis. 1999 Feb;142(2):415-23.
Jang C, Bell RJ, White VS, Lee PS, Dwyer KM, Kerr PG et
al. Women's health issues in haemodialysis patients. Med J
Aust. 2001 Sep 17;175(6):298-301.
Shamim Alam, Ihteshamul Haq. Association of ABO, Rh
blood groups systems with lipids and other anthropometric co
variables as predictors of cardiovascular risk in NWFP,
Pakistan. Ann King Edward Med Coll Jun 2004;10(2):166-9.
Kilpatrick RD, McAllister CJ, Kovesdy CP, Derose SF,
Kopple JD, Kalantar-Zadeh K. Association between serum
lipids and survival in hemodialysis patients and impact of
race. J Am Soc Nephrol. 2007 Jan;18(1):293-303.
Kalantar-Zadeh K. Recent advances in understanding the
malnutrition-inflammation-cachexia syndrome in chronic
kidney disease patients: What is next? Semin Dial. 2005 SepOct;18(5):365-9.
Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple
JD. Malnutrition-inflammation complex syndrome in dialysis
patients: causes and consequences. Am J Kidney Dis. 2003
Qureshi AR, Alvestrand A, Divino-Filho JC, Gutierrez A,
Heimbürger O, Lindholm B et al. Inflammation,
malnutrition, and cardiac disease as predictors of mortality in
hemodialysis patients.J Am Soc Nephrol. 2002 Jan;13 Suppl
Deicher R, Ziai F, Bieglmayer C, Schillinger M, Horl WH.
Low total vitamin C plasma level is a risk factor for
cardiovascular morbidity and mortality in hemodialysis
patients. J Am Soc Nephrol 2005 Jun;16(6):1811-8.
Rauchhaus M, Coats AJ, Anker SD. The endotoxinlipoprotein hypothesis. Lancet 2000 Sep 9;356(9233):930-3.
Horl WH, Cohen JJ, Harrington JT, Madias NE, Zusman CJ.
Atherosclerosis and uremic retention solutes. Kidney Int
Bro S, Bentzon JF, Falk E, Andersen CB, Olgaard K, Nielsen
LB. Chronic renal failure accelerates atherogenesis in
apolipoprotein E-deficient mice. J Am Soc Nephrol 2003
Pawlaczyk K, Oko A, Lindholm B, Czekalski S.
Malnutrition-inflammation-atherosclerosis (MIA syndrome)
in patients with renal failure. Pol Merkur Lekarski. 2003
Painter P. Physical functioning in end-stage renal disease
patients: update 2005. Hemodial Int. 2005 Jul;9(3):218-35.
Iffat Ara, Riffat Khurshid, Imran Ahmad Qureshi, Munir
Ahmad Khan. The Effect of Physical fitness on Plasma
Lipids in Young Pakistani Male Medical Students. J Rawal
Med Coll Dec 2000;4 (1-2):34-8.
Kouidi E, Grekas D, Deligiannis A, Tourkantonis A.
Outcomes of long-term exercise training in dialysis patients:
comparison of two training programs. Clin Nephrol. 2004;61